The Role of Bowel Preparation before Elective Colorectal Surgery and Its Probable Future

Abstract

Bowel preparation is a common practice among the general and colorectal surgeons world over. Its presence is still a dogma in elective colorectal surgery where bowel resection is indicated. However, it was never started with a scientific background. In the last two decades, scientists have scrutinized the role of mechanical bowel preparation through the eyes of evidence-based medicine. Single institutional and multicenter-based randomized studies indicate that bowel preparation is no longer required as a routine. It is not only ineffective in preventing complications following colorectal surgery, it is also harmful to the extent that it actually increases infective complications and anastomotic leak rates. In spite of these good evidences, surgeons globally fail to abandon the ritual. Few studies have also raised concern over the bowel preparation agents and demonstrated superiority of some over the others. At present, surgeons are at a crossroad regarding this ordeal. Though adequate and good high-level evidence has accumulated against bowel preparation, yet it is not universally condemned. Moreover, various surgical societies have failed to discretely denounce the procedure till date and the absence of consensus statements brings in the forefront the intriguing question whether it is the preparation or the agent which is at fault. Like any other procedure, which without a strong backing of evidence has gone into oblivion, bowel preparation is losing ground on its merits. The present evidence indicates that sooner or later it will be withdrawn as a practice of the yester years. Until then, this unnecessary ordeal will continue to increase the morbidity of patients undergoing elective colorectal surgery.